Clin Endosc.  2022 Jan;55(1):67-76. 10.5946/ce.2020.299.

Incidence of Infection among Subjects with Helicobacter pylori Seroconversion

• Kim YJ
• Lee SY
• Kim JH
• Sung IK
• Park HS

• KMID: 2525052
• DOI: http://doi.org/10.5946/ce.2020.299

Abstract

Background/Aims
Helicobacter pylori (H. pylori) seroconversion may occur during screening for gastric cancer. Our study aimed to assess the number of seroconverted subjects with H. pylori and their results in follow-up tests.
Methods
Data were consecutively collected on subjects who were H. pylori-seronegative and presented for gastric cancer screening. Subjects who were followed up using the same serology test and pepsinogen (PG) assays on the day of endoscopy were included in the study.
Results
During the follow-up of 57.7 ± 21.4 months, 61 (15.0%) of 407 seronegative subjects showed seroconversion. H. pylori infection was detected in six (9.8%) of 61 seroconverted subjects. A diffuse red fundal appearance, with a significant increase in the Kyoto classification scores for gastritis, was observed in the infected subjects (p<0.001). Compared to the false-seropositive subjects, infected subjects showed higher serology titers (p<0.001) and PG II levels (p<0.001), and lower PG I/II ratios (p=0.002), in the follow-up tests.
Conclusions
Seroconversion occurred in 3.3% of seronegative subjects per year; however, only 9.8% had H. pylori infection. The majority (90.2%) of the seroconverted subjects showed false seropositivity without significant changes in the follow-up test results. The diffuse red fundal appearance could be an indicator of H. pylori infection.

Keyword

Endoscopy; Gastritis; Screening

Figure

• 

  Fig. 1. Flowchart of this study. A total of 407 consecutive Helicobacter pylori (H. pylori)-seronegative subjects were included in our study. During the mean follow-up period of 57.7±21.4 months, 61 subjects showed seroconversion; meanwhile, seronegative results persisted in 346 subjects. H. pylori infection was observed in six (9.8%) of 61 seroconverted subjects.

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  Fig. 2. Development of diffuse red fundal appearance on follow-up endoscopy in an Helicobacter pylori (H. pylori)-naïve subject with new infection. (A) Initial endoscopic findings of the fundus and cardia. The Kyoto classification score was 0 (A0, IM0, H0, N0 DR0). Serum pepsinogen (PG) and serology assays showed normal results, as summarized in Table 2. (B) Findings of follow-up endoscopy performed after four years. Multiple tiny hemorrhagic spots were observed in the fundus with positive Giemsa staining. The Kyoto classification score increased from 0 to 2 (A0 IM0 H0 N0 DR2). Seroconversion in H. pylori antibodies (6.4 → 21.7 AU/mL) was reported with higher serum PG I (69.5 → 85.1 ng/ml) and PG II (18.9 → 22.5 ng/ml) levels compared to the initial test findings.

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  Fig. 3. Changes in the endoscopic findings of a subject who had a history of successful eradication four years prior to the initial visit. (A) Endoscopic findings of the fundus at the initial visit. The Kyoto classification score was 3 (A1 IM2 H0 N0 DR0). Successful eradication was confirmed by negative 13C-urea breath test findings. (B) Findings of follow-up endoscopy performed after six years. The development of diffuse red fundal appearance and positive Giemsa staining were observed. The Kyoto classification score increased from 3 to 5 (A1 IM2 H0 N0 DR2) with seroconversion (9.4 → 161.5 AU/mL). The serum pepsinogen (PG) I (46.4 → 97.2 ng/ml) and PG II (10.3 → 29.8 ng/ml) levels were higher compared to the initial test results, whereas the PG I/II ratio was lower (4.5 → 3.3).

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  Fig. 4. Findings of initial and follow-up endoscopy in a subject with unintended eradication prior to the initial visit. (A) Initial endoscopic findings of the fundus. Unintended eradication of Helicobacter pylori was considered in this study since intestinal metaplasia was observed in the biopsied specimens obtained from the antrum. Serum pepsinogen and serology assays showed normal findings, and the Kyoto classification score was 1 (A0, IM1, H0, N0, DR0). (B) Follow-up endoscopy performed after four years revealed diffuse red fundal appearance and enlarged gastric pit openings in the fundus. Positive Giemsa staining results were obtained with seroconversion (<5 → 158.1). The Kyoto gastritis classification score increased to two (A0 IM1 H0 N0 DR1).

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